Psychosocial Interventions Reduce Depressive Symptoms in CKD

New research is shedding light on the beneficial effect of psychosocial interventions for patients with chronic kidney disease (CKD), highlighting their impact on depressive symptoms in this patient population.1

Findings from the systematic review and meta-analysis suggest psychosocial interventions significantly reduce depressive symptoms compared with routine care, potentially providing a viable alternative to pharmacological treatments. Of note, no significant improvement in quality of life was observed with psychosocial interventions.1

The implications of CKD are extensive and span far beyond the kidneys—it emerges from various disease processes and can affect cardiovascular health, cognitive function, bone metabolism, anemia, blood pressure, and many other health indicators.2 As such, affected patients frequently present with depressive symptoms linked to worse outcomes, including increased morbidity and mortality.1

“Psychosocial treatments might be particularly suitable for individuals with chronic kidney disease, as they circumvent possible drug interactions and unfavorable effects of antidepressants,” Bhavneesh Saini, MBBS, MD, of the department of psychiatry at Guru Gobind Singh Medical College and Hospital in India, and colleagues wrote.1

To evaluate the efficacy of psychosocial interventions for managing depressive symptoms in patients with CKD, investigators conducted a literature search across PubMed, Embase, Google Scholar, and Cochrane Library databases from January 2007 to July 2024.1

For inclusion, studies were required to include patients diagnosed with stage 4 or 5 CKD with estimated glomerular filtration rate (eGFR) < 30 mL/min or those with CKD dependent on hemodialysis. Additionally, studies must have assessed psychosocial interventions like cognitive and behavioral therapies (CBT), physical exercise programs, counselling, and other non-drug treatments for addressing depression in the study population and contrasted the results with a control group.1

The primary outcome was the change in depressive symptoms, measured by standardized clinical tools. Quality of life was additionally explored as a secondary outcome.1

Investigators’ initial search yielded 914 records, 12 of which met the eligibility criteria and were thus included in the systematic review and meta-analysis. In total, the studies included 792 participants, including 420 in the intervention group and 372 in the control group.1

Across the included studies, CBT was the most common intervention, present in 3 (25%) studies. Investigators noted various tools were used to assess depression, with the Beck Depression Inventory being the most frequent. The follow-up durations varied, with most studies lasting between 1 to 6 months.1

Upon analysis, psychosocial interventions significantly reduced depressive symptoms compared with routine care (mean difference [MD], −4.22; 95% CI, −6.67 to −1.76; P = .0008). Investigators pointed out most studies showed a negative MD, favoring psychosocial interventions. They called attention to high heterogeneity (I2 = 89%), suggesting substantial variability among the studies.1

Sensitivity analyses re-calculating the pooled MD after removing 1 study at a time confirmed the robustness of the results.1

Investigators additionally examined the impact of psychosocial intervention on quality of life in 6 studies involving 250 participants who received psychosocial interventions and 209 who received routine care. The combined MD was 0.94 (95% CI, −0.61 to 2.49; P = .24), indicating there was no statistically significant improvement in quality of life with psychosocial interventions compared with routine care.1

“Despite the observed heterogeneity and some methodological limitations, the findings support the integration of these interventions into routine care for CKD patients to enhance their mental health and quality of life,” investigators concluded.1 “Further research is needed to confirm these findings and explore the long-term benefits and cost-effectiveness of psychosocial interventions in this population.”

References

1. Chahal JS, Saini S, Bansal P, et al. Impact of Psychosocial Interventions on Depression in Chronic Kidney Disease: A Systematic Review and Meta-Analysis. The International Journal of Psychiatry in Medicine. https://doi.org/10.1177/00912174251326009

2. Vaidya SR, Aeddula NR. Chronic Kidney Disease. StatPearls. July 31, 2024. Accessed March 7, 2025. https://www.ncbi.nlm.nih.gov/books/NBK535404/